经内镜逆行胰胆管造影在胆道术后并发症的治疗价值

Therapeutic value of endoscopic retrograde cholangio-pancreatography for complication of post-biliary operation

目的探讨经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)对胆道术后并发症的治疗价值。方法胆道术后出现各种并发症患者63例,经过ERCP检查明确病因后,对胆管结石者行括约肌切开术(endoscopic sphincterotomy,EST)或乳头气囊扩张术(endoscopic papillary balloon dilatation,EPBD)取石;对乳头炎性狭窄者行EST或EPBD治疗;对乳头旁憩室压迫肝胰壶腹者行EPBD治疗;对乳头肿瘤和胆管肿瘤者行内镜胆管内支架引流(endoscopic retrograde biliary drainage,ERBD)或内镜鼻胆管引流(endoscopic nose-bile drainage,ENBD);胆管中段狭窄行ERBD;对术后胆瘘者行ENBD治疗。结果61例(96.82%)ERCP成功;未发现胆管内异常3例;胆总管内结石34例,31例内镜下取石成功;乳头炎性狭窄5例,经EST或EPBD治疗1次成功;胆管中段狭窄7例,均行ERBD成功;3例乳头肿瘤和3例胆管肿瘤患者经ERBD或ENBD后黄疸明显减退;胆囊切除术后胆瘘2例,行ENBD后治愈,避免再次手术。总的并发症发生率为6.35%。结论ERCP能明确胆道术后的并发症并能有效地进行相应的内镜治疗。

[Objective] To evaluate the value of endoscopic retrograde cholangiopancreatography （ERCP） in treating complications of post-biliary operation. [Methods] 63 cases after bile duct operation were subjected to ERCP. After aetiology had been made clear, patients with choledocholithiasis underwent endoscopic sphincterotomy （EST） or endoscopic papillary balloon dilatation （EPBD） to extract stones; those with papillary inflammatory structure underwent EST or EPBD; those with papillary diverticulum underwent EPBD; those with papillary tumor and biliary tumor underwent endoscopic retrograde biliary drainage （ERBD） or endoscopic nose-bile drainage（ENBD）; those with biliary stricture in middle segment underwent ERBD. ENBD was successful in those with bile leakage. [Results] ERCP was successful in 61 cases （96.82%）. No obvious bihary abnormality was found in 3 cases; among 34 cases with choledocholithiasis, stones in 31 cases were totally removed after one procedure; 5 cases with papillary inflammatory structure underwent EST or EPBD successfully for one time; 4 cases had papillary diverticulum which oppressed hepatopancreatic ampull which were delt with EPBD; 7 cases had stricture in middle segment of the bile duct which were handled with ERBD; 3 patients with papillary tumor and 3 patients with biliary tumor received ERBD or ENBD and jaundice decreased sigificantly; 2 cases developed bile leakage after cholecystectomy and ENBD was successfully carried out to avoid re-operation. [Conclusions] RECP reveals definite causes of post-biliary opration＇s complications and is effective in taking corresponding endoscopic therapeutic measures.